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[Aldosterone and cardiovascular diseases, more than water and salt retention]
1Universitair Ziekenhuis Gent De Pintelaan 185, B 9000 Gent.
Insights
Aldosterone, beyond salt balance, contributes to hypertension and heart failure by affecting blood vessels and vascular function. Further research will explore its interaction with the nervous system in these conditions.
Area of Science:
- Cardiology
- Endocrinology
- Vascular Biology
Context:
- Neurohumoral systems are crucial in arterial hypertension and chronic heart failure.
- The renin-angiotensin-aldosterone system is a key player, with aldosterone's role often underestimated.
- Aldosterone is implicated in cardiovascular pathologies beyond its known effects on salt and water homeostasis.
Purpose:
- To highlight aldosterone's multifaceted role in cardiovascular disease.
- To underscore the significance of aldosterone in vascular dysfunction and remodeling.
- To introduce a new research focus on the autonomic nervous system-aldosterone axis.
Summary:
- Aldosterone contributes to left ventricular hypertrophy, reduced arterial elasticity, and endothelial dysfunction.
- Evidence suggests vascular synthesis of aldosterone, in addition to adrenal secretion.
- Aldosterone influences vascular matrix, endothelial, and baroreflex function, impacting cardiovascular health.
Impact:
- Provides insights into mechanisms underlying trials like RALES.
- Shifts focus towards aldosterone's direct vascular effects in hypertension and heart failure.
- Establishes a foundation for investigating the interplay between autonomic function and aldosterone in cardiovascular disease.
Abstract:
The activation of the different neurohumoral system plays an important role in the different mechanisms of the development and progression of arterial hypertension and chronic heart failure. The renin-angiotensin II-aldosterone system is one of the key players in this process. With the use of ACE-inhibitors in the treatment of hypertension and heart failure, less attention has been paid to aldosterone. Aldosterone has been only considered as a humoral factor playing a role in salt and water homeostasis and as a consequence controlling arterial blood pressure. There is now evidence of vascular synthesis of aldosterone besides the secretion at the adrenal cortex as well that aldosterone is involved in the development of left ventricular hypertrophy in arterial hypertension, decreased arterial elasticity of the large arteries in chronic heart failure and is inversely correlated with venous capacitance in chronic heart failure. Moreover aldosterone plays a role in the disturbances of the vascular matrix, endothelial dysfunction as well as baroreflex dysfunction. This work has contributed indirectly in the unraveling of the mechanisms which could be partly explained the results of the RALES-trial. The new research project will be focused on the study of the cross-talk between the autonomic nervous system and aldosterone in normotension, arterial hypertension and heart failure.